The Chronic Kidney Disease Problem among Aboriginals in Central Australia - Case Study Example

Health and Wellbeing Issues Affecting the Aboriginal Population in Australia Name Institution The Chronic Kidney Disease Problem among Aboriginals in Central Australia The health and wellbeing of the Aboriginal population is a key concern for the Central Australian Aboriginal Congress (CAAC). The Congress was established in 1974 to promote and improve the health of the Aboriginal population and to reduce their life expectancy gap (CAAC 2014). A review of 2011 census from the Australian Bureau of Statistics (2013) revealed that the population of Aboriginal and the Torres Strait Islander people was 548,400. This was a 21 percent increase from the previous census results of 93,300. Seventy percent of the population growth is attributed to population change (such as the increase in births) and high fertility rates. This growth was greatest in Queensland and New South Wales. Although the CAAC describes the Aboriginal people as the original owners and inhabitants of Australia, majority of the population continue to suffer from ill health and poverty due to invasion of their ancestral land by non-Aboriginal people. Prior to the settlement of non-Aboriginals, the Aboriginal people enjoyed free access to land, traditional medicine and resources. They were also relatively free from the current health problems that plague them (CAAC 2014). Presently, the Aboriginal and the Torres Strait Islanders suffer from lifestyle conditions, have low expectancy rates and have higher than national average mortality rates (Aboriginal Medical Services Alliance Northern Territory [AMSANT] 2014). A key health problem affecting this population is the prevalence of chronic kidney disease. The National Aboriginal Community Controlled Health Organization (NACCHO) (2012) reports that chronic disease is a major contributor to the life expectancy gap of the Aboriginal population. This is because incidences of diabetes, cardiovascular disease, chronic respiratory disease, chronic kidney disease and cancer have increased significantly in the last 10 years. Thirty percent of this population suffers from type 2 diabetes while those with end-stage renal diseases have increased threefold (Australian Institute of Health and Welfare [AIHW], 2013). Another report from Kidney Health Australia (2014) states that occurrence of kidney failure is higher among Indigenous Australians compared with the non-Indigenous population. It posits that the occurrence of end-stage kidney disease is 18 times higher among Aboriginals and other Indigenous Australians compared to non-Indigenous Australians. Consequently, the Aboriginals are four times more likely to die from chronic kidney disease or be hospitalized with the condition (McDonald 2013). This report investigates the chronic kidney health problem among the Aboriginal people. The purpose of the report is to describe the socially determined factors contributing to chronic kidney disease, the need for dialysis and an assessment of the dialysis services in Central Australia. The Occurrence of Chronic Kidney Disease among the Aboriginal People Chronic kidney disease is a condition of the kidney, which lasts three months, or more after a person has been diagnosed with lower kidney function or kidney damage. Kidney damage could manifest as scarring (viewed using imaging tests), the existence of protein markers (albuminuria and proteinuria) in urine, or blood in the urine (AIHW 2011). Clinical diagnosis is confirmed using the glomerular filtration rate (GFR) technique. This method reveals whether the kidneys clear waste products effectively from the blood. In advanced cases where the kidney function has reduced dramatically and kidney damage has been confirmed, the individual would be said to have end-stage kidney disease (McDonald 2013). Health statistics reveal that indigenous Australians have high incidents of kidney diseases such as chronic kidney disease and end-stage kidney disease (AIHW 2011; McDonald 2013). Between 2003 and 2007, eight percent of new cases of end-stage kidney diseases were diagnosed in Indigenous Australians. This occurrence was higher among the older populations (60 years to 80 years) compared to those below 49 years. Further, this prevalence was 6 times higher among the Aboriginal population compared to non-indigenous populations in Australia (AIHW 2013). Further investigation of the extent of the health problem among the Torres Strait Islander and the Aboriginal people shows that those living in remote areas have greater risk of developing chronic kidney diseases and have poor health outcomes (Kidney Health Australia 2014). For instance, there were 163.2 new cases of end-stage kidney disease for Indigenous patients compared to 7.8 new cases for non-Indigenous people between 2005 and 2008 (AIHW 2013). This is because Aboriginals from remote communities are less likely to seek medical services for kidney problems due to biological, social and economic factors. These risk factors include remoteness, inadequate trained personnel to manage Indigenous health, low expenditure for Indigenous populations, poverty, low birth weight, early development and house crowding. Scholars posit that these risk factors hinder Aboriginal and the Torres Strait Islander population from undergoing screening and seeking preventive health services to control the development of chronic kidney disease (AIHW 2011). They inhibit the population from seeking preventive or curative medical services thereby increasing hospitalization rates for dialysis treatments. By the time those with chronic kidney disease and end-stage kidney disease seek health services their health has already deteriorated to the point of needing a kidney transplant. The statistics show that chronic kidney disease is a serious health problem for the Aboriginal population. However, they do not provide detailed information on the biomedical, social and economic factors contributing to the prevalence of chronic kidney disease. Biomedical factors for the development of chronic kidney disease and end-stage renal disease among the indigenous people are family history, gender and diseases such as diabetic nephropathy, glorumelonephritis, reflux nephropathy and hypertension (AIHW 2011). Gender and genetics are also associated with higher risk for kidney problems among Aboriginals. Social factors which increase the risk of developing kidney disease among Aboriginals include previous kidney problem, age, low birth weight, smoking, and lack of physical activity, poor nutrition and obesity. According to AIHW (2011), more than half of the Aboriginals who have been diagnosed with chronic kidney disease are tobacco smokers, overweight or obese. These biomedical and social factors cannot be ignored because they increase the risk of death from chronic kidney complications such as hypersensitive kidney disease or kidney failure. Need for Dialysis The high incident of chronic kidney disease reveals the need for quality primary health care. However, the delivery of primary health care such as dialysis to the Aboriginal population is quite difficult. This is because Aboriginals do not seek health services with the same urgency and frequency as the non-Indigenous population. Some reasons for this behaviour include language problems, lack of transport to travel to the health centres and the cultural inappropriateness of health service. Those in remote areas have to travel long distances to the metropolitan towns for treatment. This is because the number of regional health centres cannot adequately cater to the diverse health needs of the aboriginal people (AIHW 2011). Aboriginal patients with chronic kidney disease require treatment to survive. This treatment may be a kidney transplant or dialysis. The choice of treatment depends on the type of clinical disease, location of the patient, types of treatments offered by the hospital and technological advancements in dialysis treatment (AIHW 2011). Immobility of the patient due to an injury or disability also makes it difficult to access hospital treatments for chronic kidney disease. These decision factors often disrupt the patient’s ability to receive dialysis in hospitals (haemodialysis) or at home (peritoneal dialysis). These difficulties reveal the need to develop a plan to increase access to dialysis treatments in satellite health centres and at the home. Since most of the Aboriginal people in Central Australia live in rural areas, it is difficult for them to access hospital services for haemodialysis. This explains why only 14 percent of Indigenous patients with end-stage kidney disease receive peritoneal dialysis compared to 86 percent who receive haemodialysis in major hospitals (AIHW 2011). Improving Access to Dialysis Services in Central Australia Access to home dialysis is quite low compared to haemodialysis. Access to these dialysis treatments is a challenge for Aboriginal patients who live in the remote areas of Central Australia (AIHW 2013). Providing home-based and satellite dialysis facilities is also a challenge for the government due to the resource limitations in terms of finances and trained personnel. Dialysis treatment facilities require expensive dialysis equipment, recruitment of Aboriginal health staff and cultural sensitivity training of non-Aboriginal medical personnel. A number of solutions are proposed to address this situation. First, there is a need to collect accurate data on the hospitalization rates of Indigenous Australians. Presently, the identification of indigenous people in Australia helps health care providers to assess the correct hospitalization rates and stays for Aboriginal patients seeking dialysis treatments. AIHW (2011, p.43) reports that 12 percent of hospitalizations between 2008 and 2009 were by Torres Strait Islander and Aboriginal patients with chronic kidney disease. The determination of the rates should be equally applied for indigenous and non-indigenous patients with chronic kidney disease. The reason for re-calculating hospitalization rates is to collect actual data on the increase or decrease in demand for dialysis. Using same calculation measures for hospitalization rates may reveal that the hospitalizations for Aboriginal people are mainly short-stays owing to the short duration of the dialysis treatment (AIHW 2011). The Centre for Epidemiology and Evidence (2012) agrees on the need to collect accurate data. It posits that effective data reporting is important to prevent under-reporting of health issues among Aboriginal people. Secondly, more satellite hospitals should be set up to increase health care access for Aboriginals in remote areas. Studies have shown that hospitalization rates for Indigenous Australians in remote areas are lower than the rates for those in cities and regional areas (AIHW 2011). Satellite health centres would improve access to dialysis services for Aboriginal patients in remote areas. However, setting up such structures would increase hospital and health care expenditure drastically (AIHW 2011, p.56). Presently, hospital expenditure for chronic kidney disease is highest in New South Wales, Queensland, Victoria, South Australia, Western Australia and the Northern Territory. In these states, 70 percent of expenditure for treating chronic kidney disease is used in dialysis treatment. The indigenous population only accounts for 14 percent of expenditures on dialysis. The government would need to work with local stakeholders to pool funds and create satellite health centres in remote areas within reach of most Aboriginal patients. This solution would help meet the geographical determinant of the health of the Aboriginal people (CAAC, 2014). Thirdly, health promotion programs should be designed to cater to the cultural needs and requirements of the Aboriginal people. According to the Centre for Epidemiology and Evidence (2012), the burden of disease on the minority population can be reduced by developing primary health care promotion programs. These programs would play an important role in lowering the risk factors for chronic kidney disease, encouraging early diagnosis and improving the treatment of chronic kidney disease among Aboriginal people. Moreover, a cultural outlook would help health care providers to address the social determinants of the health of Aboriginal chronic kidney patients in Central Australia. For example, cultural solutions would focus on the need to train health personnel on cross-cultural sensitivity and to provide health care materials, which have been translated into languages that are most, understood by the Aboriginal people. Looking at the cultural aspects of treatment would put greater focus on the social determinants affecting health care access such as education, employment, poverty and housing. This would reveal greater insight into the mental, emotional and social issues affecting Aboriginal patients with chronic kidney disease (Holland, Dudgeon & Milroy 2013). In addition, focusing on social determinants would reveal greater understanding on their association with poor health outcomes and low life expectancy for the Aboriginal people. It would reveal other risk factors such as substance abuse, child neglect and family violence, which exacerbate chronic kidney disease in older populations (CAAC, 2014). Understanding the role of these determinants in the overall health and well being of the Aboriginal people because it would give greater insight into the life experiences of those with chronic kidney disease, ethical concerns and moral dimensions to providing primary health care services to minority populations. Conclusion This report has investigated the nature of the chronic kidney health problem among the Aboriginal people. The purpose of the report was to describe the socially determined factors contributing to chronic kidney disease, the need for dialysis, and an assessment of the dialysis services in Central Australia. It has shown that indigenous Australians have high incidents of kidney diseases such as chronic kidney disease and end-stage kidney disease. This is because biomedical and social factors increase their risk of developing chronic kidney disease and needing dialysis when the kidney fails. The report has also shown that there is a gap between the need for health services such as dialysis and the needs of Aboriginals. Aboriginals do not use these health services with the same urgency and frequency as the non-Indigenous population due to language barriers, lack of transport to travel to the health centres and the cultural inappropriateness of health service. Consequently, the report proposes that more regional centers to be opened and equipped with dialysis machines. In addition, dialysis centres should be opened in rural towns and be staffed with Aboriginal health personnel. This will ensure that the health personnel will understand the cultural factors limiting their screening and treatment of chronic kidney disorders. References Australia Bureau of Statistics 2013, 2077.0 –Census of population and housing: Understanding the increase in Aboriginal and Torres Strait Islander Counts, 2006-2011, viewed 16 June 2014, http://www.abs.gov.au/ Australian Institute of Health and Welfare, 2011, Chronic kidney disease in Aboriginal and Torres Strait Islander people 2011, AIHW, Canberra, ACT. Aboriginal Medical Services Alliance Northern Territory (AMSANT), 2014, Indigenous chronic disease project, viewed 16 June 2014, http://www.amsant.org.au/ Australian Institute of Health and Welfare, 2013, Chronic kidney disease and Aboriginal and Torres Strait Islander people, viewed 16 June 2014, http://www.aihw.org.au/ Central Australian Aboriginal Congress, 2014, Aboriginal health: Overview, viewed 16 June 2014, http://www.caac.org.au/aboriginal-health/ Centre for Epidemiology and Evidence 2012, The health of Aboriginal people of NSW: Report of the Chief Health Officer, NSW Ministry of Health, Sidney, NSW. Holland, C, Dudgeon, P & Milroy, H 2013, ‘The mental health and social and emotional wellbeing off Aboriginal and Torres Strait Islander peoples, families and communities’, A Contributing Life: The 2012 National Report Card on Mental Health and Suicide Prevention, March, pp. 1-45. Kidney Health Australia, 2014, Fast facts on CKD in Australia: State of the nation-Chronic kidney disease in Australia- May 2014, viewed 16 June 2014, http://www.kidney.org.au/ McDonald, S 2013, ‘End-stage kidney disease among indigenous peoples of Australia and New Zealand’, Kidney International Supplements, 3, 170-173. National Aboriginal Community Controlled Health Organization, 2012, The state of Aboriginal health: Chronic disease is responsible for a major part of the life expectancy gap, viewed 16 June 2014, http://www.naccho.org.au/aboriginal-health/aboriginal-health-state/ Read More